Provider Demographics
NPI:1467820795
Name:CARE DELIVERY ALLIANCE
Entity type:Organization
Organization Name:CARE DELIVERY ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILDRESS
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, CMPE
Authorized Official - Phone:352-323-5665
Mailing Address - Street 1:701 N PALMETTO ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-4493
Mailing Address - Country:US
Mailing Address - Phone:352-323-5665
Mailing Address - Fax:352-323-1092
Practice Address - Street 1:701 N PALMETTO ST
Practice Address - Street 2:SUITE F
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4493
Practice Address - Country:US
Practice Address - Phone:352-323-5665
Practice Address - Fax:352-323-1092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization